ARE YOU READY TO MAKE A CHANGE? Name * First Name Last Name Age * Gender * Marital Status * Phone (###) ### #### Email * Social Media Handles * PAST EXPERIENCES Have you ever participated in online or in person coaching before? * Yes No If so, with who? Please describe your experience and whether you had the level of success you wanted or if you fell short of your goal and why! How could your experience have been better? Do you believe you could have applied more of yourself to the process to achieve a better result? Yes No GOALS Be detailed here, what are your specific health and fitness goals? * How would you feel if you were able to achieve your goal? (1 being not a big deal, 10 being ecstatic) * How would you feel if you failed? (1 being terrible, 10 being on top of the world) * What has been your biggest challenge in achieving your goals in the past? Please be specific (options, food, alcohol, training, schedule etc) * How can we best help you overcome this? * YOUR HEALTH Do you have any past or current health concerns, medical conditions or injuries we need to know about? BE VERY SPECIFIC * What is your current fitness level and exercise experience? Be specific * how many times a week do you train? And what type of exercise do you participate in on a weekly basis, please give us your current exercise schedule in as much detail as possible * What has motivated you to seek the help of Macro Culture? * Do you believe that if you had a plan of attack that suited your fitness level, schedule, and current life circumstances, that you are ready to give it 100%? * Yes No Thank you for applying!
